nmm 22 4500ICPSR33581MiAaIm f a u cr mn mmmmuuuu150331s2012 miu f a eng d(MiAaI)ICPSR33581MiAaIMiAaI
Addiction Health Evaluation and Disease (AHEAD) Management Study in Boston, Massachusetts, 2006-2010
[electronic resource]
Richard Saitz
,
Jeffrey H. Samet
2012-08-10Ann Arbor, Mich.Inter-university Consortium for Political and Social Research [distributor]2012ICPSR33581NumericTitle from ICPSR DDI metadata of 2015-03-31.AVAILABLE. This study is freely available to the general public.Also available as downloadable files.

Substance dependence (SD) is a chronic disease that requires specialty drug and alcohol treatment, primary care (PC), and management of related problems. Although patients with SD may be linked with specialty care and PC, their health care often remains episodic and fragmented, rather than longitudinal, comprehensive, integrated, and coordinated. As a result, adults with SD often enter addiction treatment later and require acute medical care, rather than entering the system earlier when interventions of lower intensity but longer duration might prevent catastrophes. Chronic disease management (CDM) is a collaborative, longitudinal approach to treatment of certain chronic medical illnesses proven to be more effective than routine care. CDM addresses individual patient and health systems barriers to receipt of needed treatment. However, the effectiveness of CDM for SD has not been tested. The objective of this Addiction Health Evaluation and Disease management (AHEAD) study, was to test the effectiveness of CDM for SD in PC.

Subject identification and recruitment occurred primarily at a local detoxification center, as well as by self and physician referral from the Boston Medical Center primary and ambulatory care clinics, emergency department, urgent care center, inpatient settings, and the community. The study enrolled 320 adults with drug dependence and 320 adults with alcohol dependence who were not in SD treatment, and randomized them to a SD CDM program (the AHEAD Clinic) integrated into a real-world PC clinic or to referral to standard PC. All subjects were assessed regarding SD diagnosis, substance use and problems, readiness to change, health-related quality of life, and medical and drug treatment utilization. Subjects were evaluated 3, 6, and 12 months later, and health services utilization data were collected for 2 years from a statewide database. Additionally, in order to better understand and explain the implementation and fidelity of the AHEAD Clinic, the primary care providers (PCPs) of AHEAD Clinic patients were surveyed. Each PCP was presented with a letter from the Principal Investigator explaining the purpose of the survey, the reason why s/he was being asked to complete the survey, compensation for completing the survey, and details about confidentiality and anonymity. The survey itself consisted of questions asking providers about their satisfaction and their attitudes towards caring for patients with alcohol and drug problems, their knowledge of services that the AHEAD Clinic provides, and their experience working with the AHEAD Clinic.

Primary outcomes were illicit drug use, alcohol use, substance-related problems, emergency department visits, and hospitalizations. The proposal's hypothesis was that compared with standard care, a health services delivery intervention (CDM for SD integrated in PC) would decrease alcohol and illicit drug use and related problems, and improve health care utilization patterns. Improved outcomes using the AHEAD approach would support the adoption of a health services delivery strategy, CDM, to better care for patients with SD.